FORM 1023-EZ for HELIX MEDICAL

Field Data
EIN 82-3370168
Case Number EO-2018043-000124
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HELIX MEDICAL
Organization’s Mailing Address 1935 ADDISON STREET APT 509
City BERKELEY
State CA
ZIP 94704
Accounting period End 12
Primary contact name JEFFREY LI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEFFREY LI LI
CO-PRESIDENT
1935 ADDISON STREET APT 509
BERKELEY CA 94704

Officer/Director/Trustee Two

NOLAN POKPONGKIAT
CO-PRESIDENT
1935 ADDISON STREET APT 509
BERKELEY CA 94704

Officer/Director/Trustee Three

MADELINE WU
VICE-PRESIDENT
1935 ADDISON STREET APT 509
BERKELEY CA 94704

Officer/Director/Trustee Four

BRIAN TUNG
TREASURER
1935 ADDISON STREET APT 509
BERKELEY CA 94704

Officer/Director/Trustee Five

DAISUKE SHIMADA
SECRETARY
1935 ADDISON STREET APT 509
BERKELEY CA 94704

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/27/17
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B80 - Student Services, Organizations of Students
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DAISUKE SHIMADA
Signature Title SECRETARY
Signature Date 2/7/18

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